Press release: Nursing home oversight bill signed into law

Dec 20, ’19 10:12 AM

December 19, 2019

Nursing home oversight:

Governor signs bill expanding reporting, enforcement processes

A new law expanding nursing home reporting requirements, quality oversight, and financial transparency was signed by Governor Cuomo on December 16. The bill, A4757A/S5908, was sponsored by Assembly Health Committee Chair Richard Gottfried and Senate Health Committee Chair Gustavo Rivera. The new law:

Requires nursing home employees and contractors to report all types of abuse of residents to the Health Department. The current law is limited to just physical abuse. The bill also adds reporting requirements in the event of theft from residents;
Authorizes appointment of independent quality monitors to ensure that facilities comply with written corrective plans;
Requires disclosure to DOH of any co-ownership or familial ties between the nursing home operator and anyone providing services to the nursing home;
Requires facilities to provide prospective residents with residency agreement terms, including posting residency agreements on their websites; and
Requires 90 day notice to the Department in the event of sale of nursing home properties and authorizes State recoupment of some Medicaid payments if a facility is sold to be used for purposes other than providing health care.

“To protect patient safety and quality of care, we need stronger enforcement, better transparency for residents and their families, and better screening of ownership and financial transactions,” said Gottfried. “Our next priorities must include similar legislation for adult homes and ensuring adequate staffing levels in hospitals and nursing homes.”

“This new law strengthens nursing home oversight and accountability, while further protecting residents from being victims of abuse or theft,” said State Senator Gustavo Rivera. “I look forward to working with Assembly Member Gottfried as we continue to work to enhance protections for New Yorkers as they navigate elder care services.”

“This bill establishes common-sense reporting requirements for resident abuse, neglect, and theft which will undoubtedly improve the lives of residents and save untold numbers of New York families from heartache and grief,” said Richard J. Mollot, Executive Director of the Long Term Care Community Coalition. “It also provides important oversight and financial integrity mechanisms that will help ensure that the public funds that pay for care are used wisely and efficiently. We thank Assemblymember Gottfried and Senator Rivera for their leadership in sponsoring and passing this bill in the legislature, and Governor Cuomo for signing it into law.”

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NY County Politics: Gottfried, Rivera Pen Letter Calling on DOH to save CDPA

Jul 22, ’19 12:00 PM

A new policy being implemented by the New York State Department of Health (DOH) could end up neutering the Consumer Directed Personal Assistance (CDPA) program – and New York lawmakers are begging them to reconsider.

Assemblymember Richard Gottfried (D-Chelsea, Midtown) and State Senator Gustavo Rivera (D- Kingsbridge Heights) have written a letter to the DOH to try and dissuade them from making the change.

Times-Union: Hospitals, providers urge N.Y. lawmakers to restore Cuomo health care cuts

Mar 5, ’19 10:47 PM

Health care workers, leaders and advocates swarmed the state Capitol Tuesday to urge lawmakers to restore $550 million in funds that were slashed from the governor’s original budget proposal to help plug a
larger than expected revenue shortfall.

Chanting “Don’t cut health care” and holding signs that said “Some cuts never heal,” hundreds of health care workers converged at the Empire State Plaza from all around the state and then marched to the Capitol, packing Albany’s normally busy downtown with off-duty ambulances, buses and foot traffic.

City & State: Albany’s checklist of health care bills

Jan 13, ’19 5:47 PM

By Rebecca Lewis, 12/10/18

Single-payer health care may be one of the biggest debates in Albany in 2019, but it’s just one of a number of high-profile issues dealing with medical matters. Here are summaries of several health care issues expected to be at the top of the agenda.

✓ Reproductive Health Act

Although the Reproductive Health Act has passed in the Assembly the past two years, it has yet to come up for a vote in the state Senate. A priority for many Democrats in the chamber – and, importantly, for Gov. Andrew Cuomo, who said he wants it done in January – the bill would update the state’s abortion laws and codify federal protections into state law. Although abortion rights are guaranteed under the landmark Roe v. Wade U.S. Supreme Court decision, the laws on the books in New York were passed in 1970, three years before that decision. Although the state’s laws were considered progressive at the time, they have not been updated since. Democrats have argued that if a bloc of conservative judges on the Supreme Court overturned Roe v. Wade, abortion rights in the state would revert back to those passed in 1970. State Sen. Gustavo Rivera told City & State that he hopes the legislation will be addressed early in the upcoming session now that it has the votes to pass. “I would be willing to move that very quickly because I believe that it is very important, particularly with what’s happening on the national level,” said Rivera, who is likely to be named chairman of the state Senate Committee on Health.

✓ Single-payer health care

Perhaps the most expansive and expensive item on Democratic lawmakers’ agenda – and among the most controversial – is the New York Health Act, which would establish a single-payer health care system in the state and is estimated to cost $139 billion in 2022. Many incoming lawmakers campaigned on the promise that they would get it done, but even if it does pass, massive changes likely won’t happen right away. A single-payer system means that a single entity covers the cost of all health care, which is still delivered by private or nonprofit providers. Everyone pays into a single plan run by the government, which in turn is the only provider of coverage paying claims. Assemblyman Richard Gottfried’s bill has proposed one public option and a ban on the sale of private insurance unless it offers additional coverage not included in the state plan. One major obstacle the New York Health Act must overcome is a less than enthusiastic governor. Although Gov. Andrew Cuomo has expressed support for single-payer health care as a concept, he has repeatedly said that it would be better implemented at the national level. Other critics have raised concerns about the cost, although a study performed by the Rand Corp. that found total health care spending could be lower under the New York Health Act than if the status quo were to continue.

✓ Recreational and medical marijuana

The state has been slowly inching closer to legalizing recreational marijuana. Most notably, Gov. Andrew Cuomo has been coming around on the issue. Although he used to consider marijuana a “gateway drug,” the Cuomo administration this year released a report in favor of legalization, set up a working group to draft legislation and hosted a series of listening sessions across that state to gain public input. Although legislation to legalize the drug has never passed either chamber, public support has grown substantially, and candidates, such as former gubernatorial candidate Cynthia Nixon, campaigned on the promise of legalization. The state Legislature now appears poised to pass legislation that would regulate and tax marijuana.

However, the future of the state’s existing medical marijuana program remains in limbo. Assemblyman Richard Gottfried, who sponsored the bill creating the medical marijuana program and has been one of its strongest advocates, said that in the coming session, strengthening and expanding the program will be “a major focus,” as will ensuring that it continues to run smoothly alongside potential recreational legalization. “So how we do that, I don’t know yet. But I know there is a lot of concern and brainpower being focused on it,” Gottfried told City & State. State Sen. Gustavo Rivera said he hopes that recreational legalization would also open the door for additional research to increase and expand the drug’s medical efficacy.

✓ Opioid epidemic

As the opioid epidemic continues to take lives across the state, state Sen. Gustavo Rivera told City & State that the state Senate intends to resume its work with the Task Force on Heroin and Opioid Addiction – first created in 2014 – and that state Senate Republicans could participate as well. When led by Republicans, the task force did not include Democrats. Additionally, Rivera said that the state Legislature will continue to explore the concept of harm reduction. The idea accepts that drug use will always be a part of society, but that society can take steps to cut down on the negative consequences of drugs. Namely, Rivera hopes to have productive conversations about a bill he sponsors to create safe injection sites, a highly controversial proposal to create legal locations where illegal drug users can get high in a supervised environment. “I believe that there is plenty of evidence-based programs that can be expanded and be created,” Rivera said. New York City Mayor Bill de Blasio championed a pilot program to open four such sites in the city, but the idea still faces major hurdles.

✓ Nurse staffing ratios

The issue of nurse staffing levels within hospitals has long been a priority of the New York State Nurses Association, a powerful union in the state. However, a bill on the subject has never passed the state Senate and rarely passes the Assembly. The main component of the bill would create a set ratio of patients per nurse to ensure that nurses are not overworked by caring for too many people, and to ensure that patients are receiving adequate care. However, other powerful interests have also opposed the legislation, including business groups and hospitals, who argue that while the bill addresses real problems with how care is administered, nurse staffing ratios are the wrong remedy. Like many pieces of legislation that have languished under Republican control of the state Senate, Democratic control of the chamber could give the bill a better chance to become law. “We’ve passed it before and I trust we will do it again,” said Assemblyman Richard Gottfried, who has long been a supporter of nurse staffing ratios. “And it’s very exciting that we now have a shot at having that pass the state Senate.”

Buffalo News: Editorial: Pass bill to better monitor nursing homes

Jan 13, ’19 5:42 PM

12/8/18

A story in The News on Thursday showed that it’s far too easy for the operators of nursing homes that provide low-quality care to buy more of the facilities.

The state Health Department — which reviews applications to operate nursing homes — has submitted a bill to the state Legislature that would give the department more muscular oversight of long-term care facilities. The Legislature should pass the bill when it convenes in January.

The ongoing nursing home series in The News has shown that 16 of the 47 facilities in Erie and Niagara counties have been bought since 2007 by for-profit owners from out of town. Many of the homes are among the worst-rated in Western New York.

And the state has given licenses to operate at least 10 Buffalo area nursing homes in the last decade to new owners who had been fined for providing poor care to residents at other facilities.

Few families don’t interact with nursing homes. More than 1.3 million people are in long-term care across the country, with approximately 7,000 in Erie and Niagara counties.

It’s not an easy business in which to make a profit. Despite the aging of the baby boom generation, some experts say demand for nursing home beds is going down.

“There are fewer people in nursing homes today than there were 10 years ago,” said Tony Szczygiel, a retired University at Buffalo law professor who specialized in elder laws. Szczygiel said medical advancements mean fewer nursing home stays are required after surgeries, and new home care options let some people stay in their own homes longer.

“So there’s a lot of empty beds out there,” Szczygiel said.

Bill Ulrich, a health care consultant in Washington State, said national figures indicate the industry is at an all-time low of average occupancy in nursing homes, “hovering right around 80 percent, which is very low.”

Lower demand means some Western New York facilities will eventually close. The best outcome for consumers is for the homes given the lowest ratings by the federal Centers for Medicare and Medicaid Services to be the first to go. But more vigorous oversight by the Health Department would also help.

The bill in the Legislature would authorize the Health Department to appoint an independent quality monitor at chronically deficient nursing homes, increase the amount of the maximum fine the state can impose for violations from $10,000 to $20,000, and require more ownership transparency with individuals buying homes listing if their partners are relatives. The bill, sponsored by Assemblyman Richard N. Gottfried, D-Manhattan, and Sen. Kemp Hannon, R-Garden City, hasn’t gotten out of committee.

Emerald South Nursing and Rehabilitation Center on Delaware Avenue in Buffalo was one of the troubled facilities featured in The News’ series. The home, previously operated by a company belonging to Benjamin Landa of Long Island, and later by his wife, Judy Landa, is due to close at the end of January. The Health Department imposed a $10,000 fine on Emerald South after investigating the June 4 death of an 87-year-old resident who fell to his death while attempting to climb out a window.

Benjamin Landa told The News that financial troubles at both Emerald South and Emerald North were caused by inadequate compensation from the federal government. He said the homes were running at a loss “due to the state’s grossly unfair Medicaid reimbursement schedule.”

Ulrich, the consultant, agreed that the Medicaid system in many states “does not come close to paying reasonable and adequate costs to care for Medicaid residents,” but said that nursing homes have traditionally made up the gap by taking Medicare and private pay patients that have better profit margins.

The margins are not low enough to keep Benjamin Landa out of the business. He is one of the largest nursing home operators in the state. And there are other facility operators who manage to stay afloat.

Dr. Jeffrey Rubin is chief executive officer of Elderwood Care, a for-profit chain that operates several of Western New York’s best-rated homes. Rubin says that getting the right mix of revenue is complex, involving Medicare managed care and private pay patients. “Having the right mix allows us to create a stable environment,” Rubin said.

It would be nice if the federal government’s one-star ratings for the poorest performing nursing homes caused them to clean up their act, but it doesn’t always work that way. The Gottfried-Hannon bill would at least help state health officials to not allow the owners of poorly run facilities to keep popping up in new locations.

Testimony on the New York Health Act before the New York City Council

Dec 6, ’18 3:44 PM

Testifying before the NYC Council in support of its resolution endorsing the New York Health Act, December 6, 2018

Testimony of Assembly Member Richard N. Gottfried

in Support of the New York Health Act

Public Hearing: City Council Committee on Health

New York City Hall

December 6, 2018

I am Assembly Member Richard N. Gottfried. I chair the Assembly Health Committee and I am the introducer, along with Senator Gustavo Rivera, of the New York Health Act, to create single-payer health coverage for every New Yorker. I appreciate the Council Health Committee holding this hearing on Speaker Corey Johnson’s resolution endorsing the bill. I support the resolution.

In both houses of the State Legislature, we now have solid majorities who have co-sponsored, voted for, or campaigned supporting the NY Health Act. And Governor Cuomo supports single-payer health coverage, although he says he has questions about whether it can be done at the state level.

Every New Yorker should have access to the health care they need, without financial obstacles or hardship. No one says they disagree with that. And the New York Health Act is the only proposal that can achieve that goal.

In NY State, we spend $300 billion – federal, state, and non-governmental – on health coverage. Nationally, we spend far more than any industrial democracy as a percentage of GDP. But 18 cents of the insurance premium dollar goes for insurance company bureaucracy and profit. Our doctors and hospitals spend twice what Canadian doctors and hospitals do on administrative costs, because they have to fight with insurance companies. We pay exorbitant prescription drug prices because no one has the bargaining leverage to negotiate effectively with drug companies.

Just about every New Yorker – patients, employees, employers, and taxpayers – is burdened by a combination of rising premiums, skyrocketing deductibles, co-pays, restrictive provider networks, out-of-network charges, coverage gaps, and unjustified denials of coverage. I know I am, and I bet everyone in this room is.

And those financial burdens are not based on ability to pay. The premium, the deductibles – the insurance company doesn’t care if you’re a multi-millionaire CEO or a receptionist.

In a given year, a third of households with insurance has someone go without needed health care because they can’t afford it – and usually for a serious condition.

The number one cause of personal bankruptcy is health care — even for those who have commercial health coverage.

We’ve put control of our health care in the hands of unaccountable insurance company bureaucrats. Nobody wants insurance company bureaucrats deciding what doctor you or your family can see and when.

The health insurance system means massive cost increases for most everyone and better health care for hardly anyone. It’s a disaster.

But it doesn’t have to be that way.

The NY Health Act will save billions of dollars for patients, employees, employers, health care providers and taxpayers – while providing complete health coverage to every New Yorker.

Everyone would be able to receive any service or product covered by any of the following: NY Medicaid, Medicare, state insurance law mandates, and the current state public employee benefit, plus anything the plan decides to add.

And there will be no premiums, no deductibles, no co-pays, no restricted provider network, and no out-of-network charges.

We’ll actually save billions of dollars because we get rid of insurance company bureaucracy and profit, doctors and hospitals will be able to slash their administrative costs, and New York Health will be able to negotiate much lower drug prices by bargaining for 20 million patients.

And this lower cost will be shared fairly, based on ability to pay. NY Health will be funded by broad-based progressively graduate taxes.

There will be one tax on payroll. At least 80% of it must be paid by the employer.

There will be a similar tax on currently taxable “unearned” income – like capital gains and dividends.

Because of the savings and the progressively graduated tax mechanism, 90% or more of New Yorkers will spend less and have more in their pocket.

Pumping this money back into our economy will create 200,000 new jobs in New York.

And there will be money to completely cover everyone, and make sure doctors, hospitals and other providers are paid fairly – and today, most of the time, they are not.

The vast majority of our hospitals get most of their revenue from Medicaid, Medicare, and uncompensated care pools – none of which fully cover the cost of care. The NY Health Act requires full funding for all hospital care, and hospitals will save billions in reduced administrative costs.

Here are 3 basic numbers: The savings from insurance company bureaucracy and profit, provider administrative costs, and drug prices will total $55 billion. The increased spending for covering everyone; eliminating deductibles, co-pays and out-of-network charges; and paying providers more fairly will cost $26 billion. So the net savings to New Yorkers is $29 billion.

The way our society deals with long-term care – meaning home health care and nursing home care – for the elderly and people with disabilities is a moral outrage. NY’s Medicaid does a much better job than other states. But today, New Yorkers spend $11 billion a year out-of-pocket for long-term care. And family members – usually women – provide unpaid home care worth $19 billion.

In January, Senator Rivera and I will be announcing that the NY Health Act will cover long-term care.

Now, that will use up $19 billion of the net savings. But it means no NY family will have to wipe out lifetime savings, and no family member will have to give up a career, to provide long-term care for a loved one. That’s profoundly important.

How much tax revenue will we need? With the net savings, we’ll need $129 billion from the NY Health taxes. When we add home care and nursing home care, we’ll need $159 billion.

How do we know the NY Health program will treat us – and our doctors and hospitals – fairly? Two ways.

First, the legislation explicitly requires that provider payments be reasonable, related to the cost of providing the care, and assure an adequate supply of the care. No coverage today has that guarantee.

Second, we’ll all be in the same boat; rich and poor. Every New Yorker – every voter – will benefit from the program. And every voter will have a stake in making sure our elected officials keep it as good as possible.

Remember where we started: Every New Yorker should have access to needed health care, without financial obstacles or hardship. We’re not there today. The NY Health Act will get us there. If anyone doesn’t like the NY Health Act, they should either put on the table another plan that will get us there, or admit that they’re OK with depriving millions of New Yorkers of health care or family financial stability.

Concerns have been raised by many of NY City’s municipal labor unions. They are justifiably proud of the good deal they have won for their members over the years. Good scope of coverage. The City pays the full premium. And the contract says that if there are savings in the health benefit, the savings go into a stabilization fund to pay for salaries and benefits. As they remind us: at the bargaining table they have given up wages and benefits to protect this deal.

Under NY Health, by law, every municipal employee, like every New Yorker, would have an even broader scope of benefits, and without deductibles, co-pays and restricted provider networks and out-of-network charges.

Under the bill now, collective bargaining could continue to have the City pick up the whole tab for the payroll tax and pass on the savings to the stabilization fund. But Sen. Rivera and I have offered to add bill language that by law would require the City to do that, without the need to bargain for it.

Our parents didn’t raise us to screw workers. Period. Sen. Rivera and I are determined to make sure that labor’s concerns are protected under the NY Health Act. We are continuing the dialogue with them.

Thank you for letting me testify.

City & State NY: Health Care Officials Offer Diagnoses for New York’s Funding Challenges – Richard Gottfried, Mitchell Katz and Carlina Rivera Weigh In

Feb 28, ’18 5:30 PM

(mayamaya/Shutterstock)

By City & State | February 27, 2018

Thanks to a flu season that’s one of the worst in recent memory, it has been a tough winter to stay healthy. Influenza hospitalizations are up and thousands have died. The flu vaccine has proven to be less effective than in years past, and public health experts say the disease may have yet to reach its peak. The spread of the virus is likely to continue for weeks.

It has also been a tough winter for New York policymakers and government officials who rely on Washington for funding. While congressional Republicans failed to repeal the Affordable Care Act, they’ve taken incremental steps to undermine the law, such as eliminating the individual mandate. The federal government has also reduced funding for safety net hospitals and for the ACA’s Basic Health Program, both of which play a major role in New York. Some Republicans in Washington still hope to scale back Medicaid and Medicare as well.

So we checked in with a few of New York’s top health care officials to hear their diagnosis of the situation – and how to remedy it.

Assemblyman Richard Gottfried (Jeff Coltin)

RICHARD GOTTFRIED, Chairman, Assembly Health Committee

C&S: What are your health legislative priorities this year?

RG: Our first order of business is, of course, dealing with health care cuts in the budget. This is not the worst year, not the worst budget we’ve seen, nor the best. But there are still serious cuts in health programs and restrictions in Medicaid that I and the Assembly will be trying to reverse. Beyond that, not necessarily in any particular order, passing the Reproductive Health Act in the Assembly again, and hopefully helping to advance it in the state Senate. A particular budget agenda item which we hope to deal with in the budget, and if not we will continue to try to deal with after the budget, is protecting safety net hospitals. The state’s various aid programs for hospitals are not very well targeted to get money to the hospitals that have the most serious financial need. Next, again in no particular order, is strengthening the medical marijuana program. I will be focusing on three issues there. One is to repeal the list of specific conditions for which medical marijuana can be used. There is no other drug that I know of that the law lists the conditions it can be used for. Secondly, today, only physicians, nurse practitioners and physician assistants can certify a patient for medical marijuana use. I think it makes sense that any practitioner who, under law today, can prescribe controlled substances ought to be able to certify a patient for medical use of marijuana as long as the treatment for the condition is within that practitioners scope of practice. The third piece deals with the current business model of producing, distributing and retailing, or dispensing, of medical marijuana. Today, all the licenses that have been issued require the registered organization to grow, process, distribute and dispense the product. There is almost no industry where we allow that degree of vertical integration, and certainly no industry where we require it. The next item is the New York Health Act, my single-payer bill. We will, I hope, pass that again in the Assembly as we have in the three years before. And our goal will be to continue to build support for that around that state. The last item is the Medical Aid in Dying bill that would allow an adult patient with decision-making capacity who is dying from a terminal illness to get a prescription for medication that would end their life. I think that legislation is very morally compelling for New York and I hope we can at least get it to the Assembly floor and pass it.

C&S: How would you assess the state of health care in New York based on what you’ve seen?

RG: It’s mixed. We have some of the finest health care providers, some of the finest physicians and hospitals in the country, but millions of New Yorkers still every year go without health care because they can’t afford or they suffer financially to get that care. Many of our nursing homes provide care that is well below national averages and well below standard. Our systems for inspecting nursing homes are really lacking. We need to invest a lot more of our resources into primary and preventive care, which is very difficult to do in a world where health care is controlled by insurance companies.

C&S: You mentioned your single-payer bill you would like to pass through the Assembly again. Why is that the best way forward for New York to go in in terms of health care?

RG: I believe that no New Yorker should go without health care or have to suffer financially to get it. To use the president’s term, that only gets complicated when the system is focused on the care and financing of insurance companies. And as long as our system is rooted in insurance companies, we will be spending tens of billions of dollars on, necessarily, on insurance company and health care provider administrative costs. You will have insurance companies taking thousands of dollars out of families’ pockets for premiums and deductibles and co-pays without any relation to ability to pay. And insurance companies telling us which doctors and hospitals we can go to, and which services they will pay for. To me, that’s no way to run a health care system. And I don’t know any alternative to a single-payer system that can work.

C&S: And you have seen support for that grow since you first introduced it?

RG: Oh, enormous growth and support, particularly in the last several years, because people have seen that while the Affordable Care Act made a lot of improvements, it still leaves us in the hands of the insurance companies with enormous problems. So people who thought maybe reforming the insurance system would do the job, now see that that really still leaves us falling way short. And it’s also clear that whatever health policy comes out of Washington is going to make things worse in New York, whether it’s for insurance or Medicaid or Medicare. So more than ever, people realize that, whether you call it improved Medicare for All, or single-payer, is really the only answer, and that we have really no alternative but to pursue that at the state level because it’s clearly not coming from Washington any time soon. And so we are constantly picking up more community organizations. There are activists all around the state having meetings with their state senators, there are more unions supporting the bill than ever before, so the issue really is moving forward more than I’ve ever seen.

C&S: Do you have any concerns for what is happening on the federal level, such as cuts in spending or other kinds of legislation that might affect health care in New York?

RG: Their efforts to dismantle the Affordable Care Act will undermine insurance in New York. They are already implementing cuts that are hurting the program called the Essential Plan, which is a subsidized health care program for people whose incomes are a little above Medicaid. And there will be more devastation coming to Medicaid any day now. And their next target will be Medicare. Republicans have had their eye on trashing Medicare since it was enacted in 1965. And that will be coming next. And all of that will be ripping money out of our health care system and putting more burden on out-of-pocket spending by New Yorkers who can’t afford it.

Dr. Mitchell Katz (NYC Health + Hospitals)

MITCHELL KATZ, President and CEO, New York City Health + Hospitals

C&S: What are the problems you’re facing at Health + Hospitals and what are your plans to address them?

MK: I believe, like the nuns, that there’s no mission without a margin. And so while my career has been dedicated to taking care of people who don’t have insurance, I’ve always done that by billing insurance for people who do have insurance, and attracting insured patients to my systems. Currently in Health + Hospitals, in most of our centers, we are still sending away insured patients, not providing the services that are better remunerated. This doesn’t come from a bad place, it’s sort of the history of public hospitals, that public hospitals like ours generally started before Lyndon Johnson’s Medicaid and Medicare in the ’60s when nobody had insurance. And so nobody billed and that was fine. But gradually, public hospital systems have learned how to bill and how to attract and keep paying patients, so there’s a margin to provide the care to the people who don’t have insurance. Health + Hospitals has a long way to go in that area, but this is work I’ve done in two other municipalities, and it’s well-known how to do it. And it’s a lot easier than saving people’s lives in trauma, which I’m proud my system does every day. So if we can revive a pulseless person who’s lost most of the blood volume in their body, surely we can learn how to bill insurance the way other systems do, and we are.

C&S: Could the affordable health care program that you spearheaded in California, Healthy San Francisco, work in New York City?

MK: I think that the model could work. Like a lot of other questions, it comes to participatory democracy. One of the features of Healthy San Francisco was that employers who did not provide insurance for their workers were required to pay into a fund or provide benefits or pay insurance bills. So that’s a political question as to whether or not the city would want to do that. It would have been a lot harder, maybe not impossible, but certainly a lot harder to have had the success we had in San Francisco without the employer spending requirement.

New York City Councilwoman Carlina Rivera (Ali Garber)

CARLINA RIVERA, Chairwoman, New York City Council Hospitals Committee

C&S: What has been your experience so far heading this new Committee on Hospitals?

CR: Well, it’s been educational. It’s definitely been informative as to how nuanced the issues can be. We have two other committees that are tackling issues in the health field, but we’re focused on hospitals. So what I’ve been doing is trying to meet with as many stakeholders, groups, individuals, people who are advocates, people who are retired advocates who worked in hospitals and with patients, and really try to get a broad perspective of what’s going on, how the budget, the deficit is affecting patient care, and how best we can use this committee for oversight, for investigations. But also to push forward legislation that’s going to take care of all New Yorkers. My focus is to really dive deep into Health + Hospitals, but also bring in our private partners. This is a very big network, I say it’s the most important public system in the city, and I want to make sure we’re talking about the underinsured, the insured, the undocumented and all of the people who are so dependent on the system. So again, it’s going to be a focus on the public system, but bring in our private partners as well. And it’s been eye-opening. There are a lot of people working on different campaigns, local, citywide and of course statewide, so I’m trying to, again, meet with as many different people as possible, other elected officials who are chairs of their own committees in their own legislative bodies, and then of course labor and community leaders that do the work.

C&S: Based on some of these meetings that you’ve been having, what is the most pressing issue when it comes to Health + Hospitals?

CR: I would say that would be DSH funds, Disproportionate Share Hospital programs, and that’s the funding to hospitals that treat the poorest New Yorkers. And also the risks from Washington, the threats of cuts to this very important care, these programs, the charity dollars and the way they’re distributed amongst the public and private systems. But when I talked to people, undoubtedly, one of the first things that comes up is DSH. I think it’s also about how are we going to address a billion-dollar deficit and keep 11 major hospitals open? We have the mayor’s commitment that he will keep these facilities open, but how are we going to look at underutilization in terms the spaces in these brick-and-mortar facilities? And how are we going to generate revenue? I had a really great conversation with (President and CEO of Health + Hospitals) Dr. (Mitchell) Katz, along with some of the committee staff here at the Council, just to get a little preview of some of the issues that we’re going to be going over next week. And he has some basic, I think, fundamental outlook on how to make sure we’re getting the reimbursements that we’re not getting, and to implement a more efficient system, and getting paid for the services we’re providing.

C&S: Dr. Katz is also new to Health + Hospitals, and you’re the new head of a new committee. What is that like, to have everyone who’s now trying to tackle this problem be fairly new? Is that detriment or is it good to have a lot of fresh ideas coming in?

CR: I think that’s it, you took the words right out of my mouth. I think it’s great to have fresh ideas. I think it’s good to have someone with a different perspective. He’s coming from tackling a similar issue in another major city. I come from more of the community-based care perspective. My work in Healthy Aging has been working with seniors, with very low-income families in accessing health care and navigating the Affordable Care Act. Though my experience is limited and his is incredibly comprehensive, I’m really excited because it just allows for a clear break from past issues and mismanagement, and I think that’s going to be something that’s going to be important to looking at the health care system in a different lens.

C&S: Was this a chairmanship that you had wanted? And how did you feel when you received it?

CR: Yes, of course. I think I’ve said this before, that I think that making this its own standalone, full committee, it shows the needed urgency for such an important issue. I did mention my interest to the speaker. We’re very aligned when it comes to our beliefs and values and the things we want to achieve in terms of our agenda for the City Council. So we talked a lot about health. We talked about some of the work that he had done, how I wanted to continue that work in terms of the legislation and the policy he put forward, and then bringing my own ideas based on my experience. So this was something I was interested in, and when I was assigned to it, I was very, very excited. I know that I have him for support, I have a great committee staff here and lots of advocates throughout the cities.

Assembly Health Committee Year in Review

Jan 2, ’18 3:43 PM

Assembly Health Committee Year-End Update

The Assembly Health Committee wrapped up 2017 with 34 bills signed into law and 19 vetoed, including four which were vetoed with specific agreement for further administrative actions. Some bills were signed or vetoed based on agreements to enact changes in 2018. (A governor often raises concerns and wants changes in a bill after it has been passed by the Legislature. This usually happens after the Legislature has adjourned for the year. It is not widely known to the public, but in New York it is common for a governor to insist that the leaders of the Legislature agree to changes in a bill as a condition of the governor signing it. If the legislative leaders and the bill’s sponsors agree, the governor then signs the bill and the Legislature enacts the changes early in the following year.)

The Assembly Health Committee also held public hearings including:

Home care workforce adequacy.
Adult home oversight and funding.
Health care services in state prisons and local jails.
Nursing home quality of care and enforcement.
Water quality budget implementation.
Immigrant access to healthcare.

Below are summaries of bills acted on by the Governor as well as the public hearings.

Press Advisory – 9/19 Adult Home Hearing

Sep 18, ’17 10:15 AM

Contact: For Immediate Release

Mischa Sogut September 18, 2017

(518) 455-4941
SogutM@nyassembly.gov

PRESS ADVISORY

Ensuring Adult Home Safety & Quality:
Assembly Public Hearing Will Review Quality, Oversight,
Funding of Adult Homes

On Tuesday, September 19, the Assembly Committees on Health, Aging, and Social Services will hold a public hearing in New York City on safety and quality of adult homes (“adult care facilities”) A second will be held in Syracuse on September 28 at 11 AM at the John J. Hughes State Office Building.

Adult homes house both aging individuals and those with complex medical or mental health needs, providing supportive services for independent living. They offer services less medical than nursing homes or enhanced assisted living, but more so than senior living. Adult homes are funded largely by Medicaid and the New York State Supplement Program (SSP), which provides financial support to the aged and disabled. Advocates are concerned that the current SSP rate is too low, shortchanging facilities and affecting quality of care.

The hearing will examine the availability and quality of adult home services, including the impact of increased funding for such programs. Witnesses are expected to include adult home residents, advocates, and operators.

What:

NYS Assembly public hearing on adult homes

Who:

-NYS Assembly Committees on Health, Aging, and Social Services
-Adult home residents
-Resident advocates including self-advocates
-Adult home operators

Where:
Assembly Hearing Room
19th Floor
250 Broadway

New York, NY 10007

The hearing will also be webcast live at:

http://assembly.state.ny.us/av/

When:

Tuesday, September 19
11 AM

###

Budget Update: Medicaid Long-Term Care

Apr 11, ’17 11:27 AM

It has been becoming increasingly difficult for Medicaid patients needing long-term care – especially home care for extended hours – to get the care they need. In many areas, there is a shortage of home care aides because low reimbursement rates make recruitment and retention of workers difficult. State payment rates to managed care plans discourage them from serving high-need patients properly. The methodology for assessing patient need does not adequately account for cognitive deficiency and other factors.

The newly-enacted state budget legislation (A.3007-B) includes several important actions intended to begin to turn around this siutation. In addition, the Department of Health (DOH) sent a side letter to the legislature committing to several further actions (indicated below as “Administrative action, side letter”).

Consumer Directed Personal Assistance Program (CDPAP) fiscal intermediary authorization: Requires fiscal intermediaries in the CDPAP program to register with DOH (“authorization”), and defines their scope of services. In 2015, similar legislation was vetoed and this year’s legislation comes from negotiation among the Assembly and Senate Health Committees, DOH, and the fiscal intermediaries.

CDPAP wage parity: Adds workers in the CDPAP program to the Medicaid wage parity law that currently applies to other home care workers, primarily in the downstate metropolitan region. It will phase in to reach full parity in three years. Medicaid payments to managed care plans will cover this, and managed care plans will attest to the wage pass-through in cost reports.

Uniform assessment system (UAS):
Adds “cognitive” to the current evaluation of patient “medical, social and environmental needs” required for managed care enrollees. Because of a drafting error, this provision is found in the “revenue” budget bill (A.3009-C, Part GGG) rather than in the “health” budget bill (A.3007-B).
DOH will hold regular meetings with legislators, stakeholders, and the UAS program team in order to examine and formulate improvements to the UAS. (Administrative action, see side-letter)

High-need rate cells or risk adjustments for managed long term care: (Administrative action, see side-letter.) DOH will work with legislators, advocates, providers, and managed care organizations to evaluate separate rate cells or risk adjustments for the nursing home, high-cost/high-need home and personal care, and Health and Recovery Plan (HARP) populations. Resulting adjustments will require approval by the federal Centers for Medicare and Medicaid Services.

Delaying TBI/NHTD carve-in to managed care: (Administrative action, see side-letter.) DOH will further delay the carve-in of the Traumatic Brain Injury and Nursing Home Transition and Diversion waivers into managed care from April 1, 2018 to January 1, 2019.

Nursing home bed-hold: The legislature restored the bed-hold payments for therapeutic leaves of absence at a 95% payment rate for up to 14 days annually.

Nursing home benchmark rates: The transitional “benchmark” Medicaid payment rate for nursing homes patients moving from fee-for-service to managed care will be extended until 2020.

Managed Long-Term Care (MLTC) and Adult Day Health Care (ADHC) transportation: (Administrative action, see side-letter.) DOH will not carve-out the Medicaid transportation benefit from MLTC or ADHC programs for the 2017-2018 fiscal year.

Spousal and family support: The Legislature protected the resources of family members by rejecting the Governor’s proposal to require them to pay for an individual’s long-term care before the individual could become Medicaid eligible. This was the 28th consecutive year that this has been proposed by five governors and rejected by the Legislature.

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